This patient is currently non-communicative and therefore likely lacks decision-making capacity. MCCQE ethics objectives emphasize that when a patient’s prior capable wishes are clearly known, clinicians must follow those expressed values and directives. He previously stated he did not want life-prolonging measures; escalation (hospital transfer) and potentially curative treatment aimed primarily at prolonging life would conflict with that directive. The immediate best step is to provide comfort-focused care, addressing symptoms such as fever and distress with antipyretics and other palliative measures.

Calling family to “consider antibiotics” risks substituting others’ preferences for the patient’s known wishes; substitute decision makers are meant to apply the patient’s prior expressed wishes, not override them. Starting antibiotics while waiting to contact family similarly risks initiating life-prolonging therapy inconsistent with the directive. Catheter change may be clinically useful in catheter-associated infection, but the question frames a clear limit on life-prolonging interventions; symptom relief is the priority. Ongoing care should include reassessment of comfort, clear documentation of goals of care, and communication with family about the patient’s previously stated wishes and the plan for palliative management.